RESUMO
A 55-year-old man presented to the emergency department with worsening shortness of breath 1 month after a gastrointestinal bleed. He had congestive heart failure, and an electrocardiogram suggested ischemic heart disease involvement. Echocardiography revealed a ventricular septal defect complicated by a left ventricular aneurysm in the inferior-posterior wall. Conservative treatment was started, but hemodynamic collapse occurred on the third day of admission and coronary angiography revealed a revascularizing lesion in the right fourth posterior descending coronary artery. Subsequently, his hemodynamic status continued to deteriorate, even with an Impella CP® heart pump, so ventricular septal defect patch closure and left ventricular aneurysm suture were performed. His condition improved and he was discharged on day 23 of admission and was not readmitted within 6 months after the procedure. Hemodynamic management of ventricular septal defects requires devices that reduce afterload, and clinicians should be aware of the risk of myocardial infarction after gastrointestinal bleeding.
Assuntos
Hemorragia Gastrointestinal , Aneurisma Cardíaco , Infarto do Miocárdio , Ruptura do Septo Ventricular , Humanos , Masculino , Pessoa de Meia-Idade , Ruptura do Septo Ventricular/etiologia , Ruptura do Septo Ventricular/cirurgia , Ruptura do Septo Ventricular/diagnóstico , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/diagnóstico , Aneurisma Cardíaco/complicações , Aneurisma Cardíaco/cirurgia , Infarto do Miocárdio/complicações , Ecocardiografia , Angiografia Coronária , Ventrículos do Coração/diagnóstico por imagem , EletrocardiografiaRESUMO
Asthma is a life-altering, chronic disease of heterogenous origin that features a complex interplay of immune and environmental signaling. Although very little progress has been made in prevention, diverse types of medications and delivery systems, including nanoscale systems, have been or are currently being developed to control airway inflammation and prevent exacerbations and fibrosis. These medications are delivered through mechanical methods, with various inhalers (with benefits and drawbacks) existing, and new types offering some variety in delivery. Of particular interest is the progress being made in nanosized materials for efficient penetration into the epithelial mucus layer and delivery into the deepest parts of the lungs. Liposomes, nanoparticles, and extracellular vesicles, both natural and synthetic, have been explored in animal models of asthma and have produced promising results. This review will summarize and synthesize the latest developments in both macro-(inhaler) and micro-sized delivery systems for the purpose of treating asthma patients.
